Free Opening Brief in Support - District Court of Delaware - Delaware

Case 1:04-cv-01306-GI\/IS Document 54-2 Filed 11/17/2005 Page1 0f4 I

. -- .l if C (gage 1jO4-CV-01306-GMS Document 54-2 Fi|ed_11/17/2005 Page 2 of 4 l
· ‘ Michael D. Katz, M.D. C
· g t ‘ Pediatric Neurology _, _ "
. July 1, 2005 · .
· Mr. Robert Hunn E
Law Offices of , _ -
_» Kolsdy, Gordon, Robin, Shore, & Bezar . if
T 1 Liberty Place, 22“° Floor h ‘- , .
. 1650 Market Street , .
Philadelphia, PA 19103 · _ ‘ I
RE: Laag, Catherine s ` l
DATE OF BIRTH: 08/22/ 1 993 · _ s
Dear Mr. Hunn: j · "
i . Il have reviewed th following medical records of Catherine Laag. The Medford Pediatrics ‘
‘ ` E and Adolescent medicine rcords§ the Virtua`West Jersey Hospital records; the Al. Dupont
Hospital for Children records; the Voorhees Pediatric`Center records; and the Shamong
Township School District records.. . . ‘· ·
On August 25, 2003, Catherine Laag presented to her pediatrician Medford -Pcdiatri·c and,
' Adolescent Medicine with a several day history of fever, coughing, and congestion She-was ` E
· diagnosed with a- virus and sent home. Roughly two days later Catherine presented to Virtua J
West Jersey Hospital in respiratory distress. She had many ofthe symptoms of rnycoplasma
` pneumonia and was transferred to A.I. Dupont Hospital for Children in Wilmington, DE for
further care. She was admitted there on the saine_da}’,A¥1§\iSt27Q—2UO3-. mitially Catherine ¤
- - was placed on nasal BiPAP 10 to 15 liters per minute. A chest ieray showed a small pleural -
_ effusion. oa August 29, 2003, because of decreasing oxygen saturationand increase work of
— ‘ breathing, Catherine was intubated. Catherine was fairly stable on a ventilator as well as on ‘ ’
N antibiotics. Her respiratory status was noted to be critical and her respiratory problem ._ ‘
were probably that much more fragile because of her diagnosis of Down syndrome. lt was _
‘ M decided that Catherine would-be extubated. Her sedation was decreased, Catherine awoke,
and on4Septemher 9 at approximately ll:35Catherine was eirtubated. She was noted to be i ii
quite agitated most likely secondary to hypoxia andseveral attempts were made to re- ‘· ·e ` j
intubate her. These attempts were unsuccessful and Catherine had a full cardiacand i
‘ respiratory arrest at 12:05. Eventually Catherine was re-intubated after muldple attempts,
_ andthe notation in her chart was that Catherine was re-intubated
l ‘ 77.li’r0$pect Avenue *· Hackensack, N] 07601 l Phoniz: 20l—525-4777 ‘ Fax: 20l-525—·¢l·770 l
333 Westchester Avenue _§'uite :Ei 04 " Wl1ite_Plains,·NY 10605 * Phone: 9144,28-6777 -‘
_ n Email; MKATZl\[email protected] _ - Z

it fc ·· Case 1 :04-cv-01306-GI\/IS Document 54-2 Filed 11/17/2005 Page 3 of 4 .
approximately 20 minutes after beginning a full code. Catherine was seen by the
pediatric neurologist at A.I. Dupont who described clearly a hypoxic event. On October
· 3, 2003, Catherine underwent a tracheostomy, and on October l0, 2003, a gastrostomy
tube was placed.
On April 18, 2005, at approximately ll:20 a.m., I visited Catherine and formally
examined her at her residential facility in Voorhees, NJ. Her medication at that time `
included Robinul l mg every 4 hours, fluoride, Maalox with Prevacid, baclofen 10 mg 3
times a day, Tegretol 150 mg 3 times a day, Valium 1 mg every 8 hours, Colace 200 mg a
day, Glycollax 225 grams, Prevacid 30 mg I q. day. Her p.r.n. medications include
. Tylenol, Motrin, bisacodyl, F1eet’s enemas, and Viokase to unclog the tube as necessary. g _
PHYSICAL EXAMINATION: Her vital signs the day I saw her were a temperature of —
99.6. Her weight was approximately 90.5 pounds. Her blood pressure was 104/67. She
was on room air with mist. Her heart rate was 114. I-Ier respiratory rate was 23 breaths _?
‘ per minute. Pulse oximeter read 92 to 93. Her physical exam showed discs to be flat.
She was unable to visually track. Pupils are briskly reactive. She had a protuberant —
` tongue with quite classic Down facies. She blinked to threat in both left and right eye.
She had Hsting bilaterally with cortical thumbs. She has extensive posturing. She had no
spontaneous vocalization. She had increased tone in both upper and lower extremities. i
She had no voluntary movements noted. She had an abnormal spread of reflexes in the _
upper and lower extremities with 2+ reflexes at the biceps, triceps, and wrists, 2+ at the
. patellar reflex, 3+ at the ankles. Both her ankles were evertd, and she wore splints to try
to reduce them to 90 degrees, although that was almost impossible. She had 2-3 beats of _
· clonus- She had extensive spasm. She had her gastrostomy tube replaced. She did
respond to touch in an involuntary manner. She had an obvious palmar crease. She had
no skin breakdown. Abdomen was flat._ She had a scar hom previous surgery. She had a `
_ GJ button and was receiving continuous feeds of Promote at 77 mL an hour. She was
. also receiving chest PT 3 times a day. She had a trach collar in place approximately 12
hours, receiving Pulmicort as well as albuterol, and was receiving albuterol treatments 4 .
times a day. ‘ — F ‘
- It is my opinion to a reasonable degree of medical certainty that-there was a direct `
correlation between the failed extubation and Catherine’s hypoxic ischemic i
encephalopathy. Catherine is currently in a persistent vegetative state and requires a high -
level of care. Prior to Catherine’s injury, Catherine was a functioning young lady with a
diagnosis of Down syndrome. MRI of the brain on September 18, 2003 shows a cortical
basal ganglia edema consistent with global ischemia, and an EEG performed on
September 15, 2003 revealed a severely abnormal EEG once again consistent with a `»`' ’
diagnosis of hypoxic ischemic encephalopathy. l
Catherine, with the high level of care she is currently receiving, is very stable medically. , `
She has no skin breakdown. She is receiving nutrition. Her skin is in good condition.
_ She is gaining weight nicely and is continuing to grow and thrive. ;

J T_ Case 1 :04-cv-01306-GIVIS Document 54-2 Filed 1 1/17/2005 Page 4 of 4 an
an- Catherine’s life expectancy and median survival rate is clearly reduced in
comparison to another individual who isnot in a persistent vegetative state. Life
_ expectancy for a person with Down syndrome has been reported to be 58.6 years. .
Life expectancy is simply an average number of years lived by a large group of
` · similar persons. Life expectancy figures are an ever changing profile with life _
expectancies increasing for those born more recently. In evaluating Catherines
circumstances, i.e. the level of care she is receiving, her age at the time of the insult, her
overall health including her health prior to the insult, and that she lived a year and a -
half since the severe anoxia occurred, it is my opinion that Catherine can be expected to -
live into her late twenties or early to mid thirties and assuming she stays healthy, I —
believe it is reasonable to expect her live even longer. 3
*SineereIy, ‘
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